Provider Relations Specialist

Overview

Profile

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

This position supports the department leadership in the overall management of provider education as it relates to Tri West provider networks. Ensures high level of customer satisfaction by serving as the consulting resource for the Provider Services Department and Tri West contracted providers. Serves as the subject matter expert by educating providers on Tri West reimbursement methodologies, provider education content, contract requirements, and new programs.

Ensures provider rosters, records and reimbursement rates are accurate and up to date. Provides suggestions to update provider education materials based on trends and operates as intermediary between providers and Tri West staff on provider education needs. Facilitates resolution of escalated provider issues and communicates outcomes. This position must keep current and follow VA, Tri West, and departmental policies and procedures and submit reports in a timely manner.

Required:

• Bachelor's (BA/BS) Degree in health care or related field or equivalent experience.
• 3 years’ managed health care experience (provider relations and/or provider education) or experience working for a health care provider, with increasing responsibility.
• Ability to work in a highly matrixed environment.
• Ability to work in a fast-paced environment and triage constantly changing priorities.

Preferred:

• Experience processing referrals/authorizations or claims or handling escalated provider issues to resolution.
• Experience with healthcare-related electronic transactions and reimbursement methodologies.
• Experience in leading and facilitating meetings.
• Provider contracting experience.

• Assists Alaska direct contract managers in contracting actions with providers and maintenance of their network records. O document and follow-up on access to care issues. Establish and maintain positive working relationships with both internal and external customers. Responding to emails, phone calls, customer service inquiries by fully researching inquiry and responding timely. Subject matter expert of VA payment methodologies and Tri West policies and procedures for the administration of the VA Program.
  
  Coordinate and support timely provider contracting and re-contracting projects. Issue management and resolution of escalated issues; resolving provider issues in collaboration with Claims and Operations departments and reporting updates to the VA.
• Maintains professional working relationship with other Tri West departments, providers and stays abreast of provider educational needs. Remains current on all VA, Tri West and departmental policies and procedures by taking all available training and reviewing e-mail, Tri Net, and  communications. Recommends future provider educational needs based on observations of and discussions with providers and provider questions during live and web-based training.
  
  Provides feedback to management of any claims processing, referral/authorization, or other unfavorable trends from provider interactions. Actively promotes electronic claims submission & secure website functionality in all provider interactions. Maintains accurate provider contact records in the contact management system. Reviews and submits feedback timely on draft provider educational materials. Assists/participates in projects as assigned by manager. Performs other duties as assigned.
  
  Regular and reliable attendance is required.

• Communication / People
  
  Skills:
  
  Ability to influence or persuade others under positive or negative circumstances;
  Adapt to different styles;
  Listen critically;
  Collaborate.
• Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, Tri West Intranet, the Internet, and department software applications.
• Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes;
  Commitment to task to produce…